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Bukoski A, Downs J, Hodgson DS, Le-Bert CR, Thomen R, Flors L, Thombs L, Bailey J. Cardiopulmonary effects of apneustic anesthesia ventilation in anesthetized pigs: a new mode of ventilation for anesthetized veterinary species. Front Vet Sci 2024; 11:1378617. [PMID: 38855412 PMCID: PMC11157129 DOI: 10.3389/fvets.2024.1378617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Objective To compare the cardiopulmonary effects of apneustic anesthesia ventilation (AAV) and conventional mechanical ventilation (CMV) in anesthetized pigs and to describe a new mode of ventilation for anesthetized veterinary species. Study design Randomized, crossover design without washout. Animals Twelve healthy, female white Landrace pigs. Methods Following ketamine-midazolam premedication and anesthetic induction with propofol, the trachea was intubated, and each pig was positioned in dorsal recumbency. Anesthesia was maintained with propofol and sufentanil infusions. Pigs were instrumented and their lungs were sequentially ventilated with each mode, in random order, for 1 h according to predefined criteria [fraction of inspired oxygen (FiO2) = 0.21, 10 mL kg-1 tidal volume (VT), and arterial carbon dioxide tension (PaCO2) within 40-45 mmHg]. Cardiopulmonary data were collected at baseline, 30 and 60 min. In 8 pigs, thoracic computed tomography (CT) was performed following the 60 min time point for each mode of ventilation and images were analyzed to quantify lung aeration. The effects of ventilation mode, time, and order were analyzed using repeated measures ANOVA. Paired t-tests were used to compare lung aeration between modes. Significance was defined as p < 0.05. Results Data from 12 pigs were analyzed. A significant effect of mode was found for heart rate, mean arterial pressure (MAP), pulmonary artery occlusion pressure, cardiac index (CI), stroke volume index, systemic vascular resistance, pulmonary vascular resistance, oxygen delivery index (DO2I), oxygen extraction ratio (O2ER), VT, arterial oxygen tension, arterial hemoglobin saturation, PaCO2, end-tidal carbon dioxide tension, alveolar dead space (VDalv/VTalv), venous admixture (Q . s / Q . t ), mean airway pressure, and dynamic compliance index (CRSI). Order effects were also observed for some cardiovascular and respiratory variables. For the eight pigs that underwent thoracic CT, AAV resulted in significantly larger proportions of normally and hyperaerated lung while CMV resulted in larger proportions of hypoaerated and atelectatic lung. Conclusions In dorsally recumbent anesthetized pigs, ventilated with FiO2 = 0.21, both modes of ventilation supported adequate oxygenation while AAV resulted in higher CRSI, and lower VDalv/VTalv andQ . s / Q . t , compared with CMV. AAV was also associated with lower MAP, CI, and DO2I and higher O2ER compared with CMV. Further investigation of AAV in anesthetized animals is warranted.
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Affiliation(s)
- Alex Bukoski
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - John Downs
- Innovative Veterinary Medicine, Ponte Vedra, FL, United States
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - David S. Hodgson
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Carolina R. Le-Bert
- U.S. Navy Marine Mammal Program, Naval Information Warfare Center Pacific, San Diego, CA, United States
| | - Robert Thomen
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Lucia Flors
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lori Thombs
- Department of Statistics, College of Arts and Science, University of Missouri, Columbia, MO, United States
| | - James Bailey
- Innovative Veterinary Medicine, Ponte Vedra, FL, United States
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Midon M, Yamada DI, Filho DZ, Natalini CC, Escobar A, Clark-Price SC. Evaluation of the effects of doxapram in combination with xylazine on recovery of horses isoflurane-anesthetized. J Equine Vet Sci 2022; 111:103872. [DOI: 10.1016/j.jevs.2022.103872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Loomes K, Louro LF. Recovery of horses from general anaesthesia: A systematic review (2000-2020) of the influence of anaesthetic protocol on recovery quality. Equine Vet J 2021; 54:219-261. [PMID: 34668220 DOI: 10.1111/evj.13524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The recovery phase after equine general anaesthesia (GA) is a time of considerable risk and therefore has been the subject of extensive research over the last 20 years. Various pharmacological interventions have been developed and studied with the objective of improving recovery quality and reducing anaesthetic-related mortality and morbidity. Nevertheless, some controversy remains regarding the influence of anaesthetic protocol choice on recovery quality from GA and its implications for recovery-related mortality and morbidity. A systematic review of the literature investigating the influence of anaesthetic protocol choice on recovery quality is currently lacking. OBJECTIVES To perform a detailed evaluation of the equine veterinary literature investigating the effect of anaesthetic protocol choice on equine recovery quality utilising the GRADE framework. STUDY DESIGN A systematic evaluation of the equine veterinary literature was performed using the GRADE framework. METHODS A literature search was performed and studies were assessed for eligibility by both authors utilising PRISMA guidelines. Studies meeting inclusion criteria were evaluated by both authors, categorically summarised and the quality of evidence for each sub-topic was assessed using the GRADE framework. RESULTS A total of 124 studies were identified which directly assessed the impact of anaesthetic protocol choice on recovery quality after GA in horses. Evaluation of the available evidence indicated that certain partial intravenous anaesthesia (PIVA) agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality. MAIN LIMITATIONS The validity of the results of some studies may have been compromised by missing data and small sample sizes. CONCLUSIONS There is evidence to indicate that certain PIVA agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality.
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Louro LF, Robson K, Hughes J, Loomes K, Senior M. Head and tail rope-assisted recovery improves quality of recovery from general anaesthesia in horses undergoing emergency exploratory laparotomy. Equine Vet J 2021; 54:875-884. [PMID: 34541712 DOI: 10.1111/evj.13516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/21/2021] [Accepted: 09/03/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND In equine anaesthesia, the recovery period is critical, accounting for most anaesthesia-related fatalities reported. Horses may recover unassisted or may be assisted, for example, using a head and tail rope recovery method. OBJECTIVES To compare the impact of head and tail rope and unassisted recovery method on quality of recovery in horses undergoing colic surgery under general anaesthesia (GA). STUDY DESIGN Single centre retrospective cross-sectional study, with prospective model performance analysis. METHODS Clinical data were obtained from horses undergoing emergency exploratory laparotomy over a 6-year period. Multivariable logistic regression analysis was used to identify the perioperative factors that affect quality of recovery. The final prediction model was assessed prospectively. RESULTS Records from 502 general anaesthetics (490 horses) were included. Multivariable logistic regression analysis showed that head and tail rope recovery (OR 2.2, 95% CI 1.4-3.3, P < .001) and sevoflurane administration (OR 1.6, 95% CI 1.2-2.3, P = .02) were associated with better quality of recovery when compared with unassisted recovery and isoflurane administration respectively. Increasing GA duration (OR 1.0, 95% CI 0.99-1.0, P = .03), increasing intraoperative dosages (in mg/kg) of thiopental (OR 0.85, 95% CI 0.75-0.98, P = .02) or ketamine (OR 0.67, 95% CI 0.46-0.99, P = .04) were linked to poor quality of recovery. No statistically significant difference was found between recovery groups in terms of mortality. MAIN LIMITATIONS The clinical prediction model obtained is only applicable to the specific facilities, recovery methodology, referral population and anaesthetic protocols practiced at our institution. CONCLUSIONS Head and tail rope recovery is significantly associated with better quality of recovery, compared with unassisted recovery, in horses undergoing emergency exploratory laparotomy. Sevoflurane administration, in detriment of isoflurane, was associated with better quality of recovery. Other risk factors, such as increasing GA duration, the use of higher intra-operative dosages of ketamine and/or thiopental, were associated with poor quality of recovery.
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Affiliation(s)
- Luís Filipe Louro
- School of Veterinary Science, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - Katherine Robson
- School of Veterinary Science, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - Jodie Hughes
- North Downs Specialist Referrals, Bletchingley, UK
| | | | - Mark Senior
- School of Veterinary Science, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
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Stefanik E, Drewnowska O, Lisowska B, Turek B. Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia. Animals (Basel) 2021; 11:2049. [PMID: 34359177 PMCID: PMC8300395 DOI: 10.3390/ani11072049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
Horses, due to their unique anatomy and physiology, are particularly prone to intraoperative cardiopulmonary disorders. In dorsally recumbent horses, chest wall movement is restricted and the lungs are compressed by the abdominal organs, leading to the collapse of the alveoli. This results in hypoventilation, leading to hypercapnia and respiratory acidosis as well as impaired tissue oxygen supply (hypoxia). The most common mechanisms disturbing gas exchange are hypoventilation, atelectasis, ventilation-perfusion (V/Q) mismatch and shunt. Gas exchange disturbances are considered to be an important factor contributing to the high anaesthetic mortality rate and numerous post-anaesthetic side effects. Current monitoring methods, such as a pulse oximetry, capnography, arterial blood gas measurements and spirometry, may not be sufficient by themselves, and only in combination with each other can they provide extensive information about the condition of the patient. A new, promising, complementary method is near-infrared spectroscopy (NIRS). The purpose of this article is to review the negative effect of general anaesthesia on the gas exchange in horses and describe the post-operative complications resulting from it. Understanding the changes that occur during general anaesthesia and the factors that affect them, as well as improving gas monitoring techniques, can improve the post-aesthetic survival rate and minimize post-operative complications.
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Affiliation(s)
- Elżbieta Stefanik
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797 Warsaw, Poland;
| | - Olga Drewnowska
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797 Warsaw, Poland;
| | - Barbara Lisowska
- National Geriatrics, Rheumatology and Rehabilitation Institute, Spartańska 1, 02-637 Warsaw, Poland;
| | - Bernard Turek
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 100, 02-797 Warsaw, Poland;
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Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals (Basel) 2021; 11:ani11061777. [PMID: 34198637 PMCID: PMC8232193 DOI: 10.3390/ani11061777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions. Abstract Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.
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White KL, Hird JFR, Taylor PM. Sevoflurane or isoflurane anaesthesia? A prospective, randomised blinded clinical trial in horses undergoing elective surgery. Vet Rec 2021; 189:e507. [PMID: 34047371 DOI: 10.1002/vetr.507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/26/2021] [Accepted: 04/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Isoflurane is the only volatile anaesthetic agent licensed for equine use in the United Kingdom, but sevoflurane is also commonly used. The two agents have rarely been compared for use in clinical elective surgery. METHODS This single centre, prospective, randomised, blinded clinical investigation recruited 101 healthy client owned horses undergoing elective surgery. Anaesthesia was standardised and horses randomly assigned to receive isoflurane (I) or sevoflurane (S) for maintenance of anaesthesia in 100% oxygen. Horses were ventilated to normocapnia and received intravenous fluid therapy and haemodynamic support with dobutamine to maintain mean arterial blood pressure above 60 mm Hg. Recovery was timed and video-recorded to allow offline evaluation by two experienced clinicians unaware of the volatile agent used. No post-anaesthetic sedation was administered. RESULTS There was no significant difference between groups in terms of haemodynamic support required during anaesthesia nor in quality or duration of recovery. Inotropic support to maintain MAP above 60 mm Hg was required by 67 of 101 (67%) of horses. Five horses in the I group required additional ketamine or thiopentone to improve the plane of anaesthesia. CONCLUSIONS Haemodynamic support needed during anaesthesia as well as the duration and quality of recovery were similar with isoflurane and sevoflurane.
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Affiliation(s)
- Kate L White
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, UK
| | - John F R Hird
- Shelf Equine Hospital, Lower Giles Hill Farm, Halifax, West Yorkshire, UK
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9
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Hector RC, Rezende ML, Mama KR, Hess AM. Recovery quality following a single post-anaesthetic dose of dexmedetomidine or romifidine in sevoflurane anaesthetised horses. Equine Vet J 2020; 52:685-691. [PMID: 31975413 DOI: 10.1111/evj.13238] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/13/2019] [Accepted: 01/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Post-anaesthetic sedation is administered to horses to improve recovery quality from inhalant anaesthesia and reduce the risk of catastrophic injury. A single dose of dexmedetomidine for this purpose has not been evaluated clinically. OBJECTIVES To determine whether dexmedetomidine improves recovery quality from sevoflurane anaesthesia compared to a previously studied dose of romifidine. STUDY DESIGN Prospective, randomised, masked clinical trial. METHODS Ninety-nine, adult, client-owned horses anaesthetised for elective procedures completed the trial. Anaesthetic protocol was standardised. Horses were randomly assigned to receive either dexmedetomidine 1 mcg/kg bwt (D) or romifidine 20 mcg/kg bwt (R) intravenously at their first spontaneous breath in recovery. Recoveries were reviewed and independently assigned subjective visual analogue scale (VAS) scores (0-100 mm, worst to best) for overall quality and standing ataxia scores (1-4, none to severe) by two anaesthesiologists blinded to treatment group. Objective anaesthesia and recovery data were also recorded. Comparisons were made using the Chi-square, Wilcoxon rank sum, linear models or Welch-Satterthwaite two-sample t-test (P ≤ .05). Predictors of VAS score were analysed independent of treatment group. RESULTS There were no significant differences between groups except end-tidal sevoflurane (FE´Sevo) concentration and post-induction extra ketamine dosing. Including FE´Sevo and additional ketamine in the analysis as covariates, VAS scores and time to standing were not significantly different between groups. Increased age, not receiving a nerve block, increased duration of hypotension, and having a nervous temperament were significant predictors of VAS score. MAIN LIMITATIONS No universal recovery scale exists for inter-study comparisons. CONCLUSIONS After sevoflurane anaesthesia, sedation with dexmedetomidine or romifidine provides clinically similar recovery time and quality.
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Affiliation(s)
- Rachel C Hector
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Marlis L Rezende
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Khursheed R Mama
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ann M Hess
- Department of Statistics, College of Natural Sciences, Colorado State University, Fort Collins, CO, USA
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Mosing M, Senior JM. Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation. Equine Vet J 2018; 50:282-291. [DOI: 10.1111/evj.12793] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/24/2017] [Indexed: 01/06/2023]
Affiliation(s)
- M. Mosing
- Murdoch University School of Veterinary and Life Sciences; Murdoch Western Australia Australia
| | - J. M. Senior
- Department of Equine Clinical Science; Institute of Veterinary Science; University of Liverpool; Neston Cheshire UK
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Platt JP, Simon BT, Coleman M, Martinez EA, Lepiz MA, Watts AE. The effects of multiple anaesthetic episodes on equine recovery quality. Equine Vet J 2017; 50:111-116. [PMID: 28772349 DOI: 10.1111/evj.12728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although rare, 70% of equine fatalities during recovery from general anaesthesia (GA) are due to catastrophic fractures from poor recovery quality. OBJECTIVE To determine the effect of repeated GA recovery on GA recovery quality. STUDY DESIGN Experimental blinded trial. METHODS Eight adult horses underwent six GA events on sevoflurane for distal limb MRI examination over a 14-week period. Prior to GA recovery, xylazine was administered. Randomly ordered video-recorded GA recoveries were scored by three blinded board certified veterinary anaesthesiologists, unaware of patient identity or GA event number, for nine parameters using a 100 mm visual analogue scale (VAS) where 0 = worst and 100 = best. The number of attempts to stand, duration of lateral and sternal recumbency, total recovery duration and physiologic parameters during each GA event were recorded. Repeated measures ANOVA were used to detect differences. Agreement between observer VAS scores was determined via inter-rater reliability using an intraclass correlation. RESULTS With GA recovery experience, VAS scores for balance and coordination, knuckling, and overall quality of recovery were improved and the duration of lateral recumbency was increased. There were no differences in total recovery duration, number of attempts to stand, physiologic parameters other than heart rate during GA, or VAS scores for activity in lateral recumbency, move to sternal, move to stand, or strength. MAIN LIMITATIONS Each GA event was relatively short and there was no surgical stimulation. The same results may not occur if there was surgical stimulation and pain during each GA event. CONCLUSION Recovery from GA improves with multiple anaesthetic episodes in horses. Clinicians can advise clients that horses are likely to have better GA recovery on repeated GA recovery due to improved balance and coordination and reduced knuckling. Additionally, there is no change in anaesthetic morbidity with six repeated GA events over a 14-week period.
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Affiliation(s)
- J P Platt
- Comparative Orthopedics and Regenerative Medicine Laboratory, Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - B T Simon
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - M Coleman
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - E A Martinez
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - M A Lepiz
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - A E Watts
- Comparative Orthopedics and Regenerative Medicine Laboratory, Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
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Thompson KR, Bardell D. The effect of two different intra-operative end-tidal carbon dioxide tensions on apnoeic duration in the recovery period in horses. Vet Anaesth Analg 2015; 43:163-70. [PMID: 26031444 DOI: 10.1111/vaa.12277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/22/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the effect of two different intraoperative end-tidal carbon dioxide tensions on apnoeic duration in the recovery period in horses. STUDY DESIGN Prospective randomized clinical study. ANIMALS Eighteen healthy client-owned adult horses (ASA I-II) admitted for elective surgery. Horses were of a median body mass of 595 (238-706) kg and a mean age of 9 ± 5 years. METHODS A standardized anaesthetic protocol was used. Horses were positioned in dorsal recumbency and randomly allocated to one of two groups. Controlled mechanical ventilation (CMV) was adjusted to maintain the end-tidal carbon dioxide tension (Pe'CO2 ) at 40 ± 5 mmHg (5.3 ± 0.7 kPa) (group 40) or 60 ± 5 mmHg (8.0 ± 0.7 kPa) (group 60). Arterial blood gas analysis was performed at the start of the anaesthetic period (T0), at one point during the anaesthetic (T1), immediately prior to disconnection from the breathing system (T2) and at the first spontaneous breath in the recovery box (T3). The time from disconnection from the breathing system to return to spontaneous ventilation (RSV) was recorded. Data were analysed using a two sample t-test or the Mann-Whitney U-test and significance assigned when p < 0.05. RESULTS Horses in group 60 resumed spontaneous breathing significantly earlier than those in group 40, [52 (14-151) and 210 (103-542) seconds, respectively] (p < 0.001). Arterial oxygen tension (PaO2 ), pH, base excess (BE) and plasma bicarbonate (HCO3-) were not different between the groups at RSV, however, PaO2 was significantly lower in group 60 during (T1) and at the end of anaesthesia (T2). CONCLUSIONS AND CLINICAL RELEVANCE Aiming to maintain intra-operative Pe'CO2 at 60 ± 5 mmHg (8.0 ± 0.7 kPa) in mechanically ventilated horses resulted in more rapid RSV compared with when Pe'CO2 was maintained at 40 ± 5 mmHg (5.3 ± 0.7 kPa).
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Affiliation(s)
- Kate R Thompson
- Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | - David Bardell
- Philip Leverhulme Equine Hospital, University of Liverpool, Neston, UK
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Valente ACS, Brosnan RJ, Guedes AGP. Desflurane and sevoflurane elimination kinetics and recovery quality in horses. Am J Vet Res 2015; 76:201-7. [DOI: 10.2460/ajvr.76.3.201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wiese AJ, Brosnan RJ, Barter LS. Effects of acetylcholinesterase inhibition on quality of recovery from isoflurane-induced anesthesia in horses. Am J Vet Res 2014; 75:223-30. [PMID: 24564307 DOI: 10.2460/ajvr.75.3.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare effects of 2 acetylcholinesterase inhibitors on recovery quality of horses anesthetized with isoflurane. ANIMALS 6 horses in phase 1, 7 horses in phase 2A, and 14 horses in phase 2B. PROCEDURES The study comprised 3 phases (2 randomized, blinded crossover phases in horses undergoing orthopedic procedures and 1 prospective dose-determining phase). In phase 1, horses were anesthetized with isoflurane and received neostigmine or saline (0.9% NaCl) solution prior to anesthetic recovery. Phase 2A was a physostigmine dose-determining phase. In phase 2B, horses were anesthetized with isoflurane and received neostigmine or physostigmine prior to recovery. Objective recovery events were recorded and subjective visual analogue scale scores of recovery quality were assigned from video recordings. RESULTS Recovery measures in phase 1 were not different between horses receiving neostigmine or saline solution. In phase 2A, 0.04 mg of physostigmine/kg was the highest cumulative dose that did not cause clinically relevant adverse behavioral or gastrointestinal effects. Horses receiving physostigmine had higher mean ± SD visual analogue scale recovery scores (70.8 ± 13.3 mm) than did horses receiving neostigmine (62.4 ± 12.8 mm) in phase 2B, with fewer attempts until sternal and standing recovery. Incidence of colic behavior did not differ among groups. CONCLUSIONS AND CLINICAL RELEVANCE Inhibition with physostigmine improved anesthetic recovery quality in horses anesthetized with isoflurane, compared with recovery quality for horses receiving neostigmine. Inhibition of central muscarinic receptors by inhalation anesthetics may underlie emergence delirium in horses recovering from anesthesia.
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Affiliation(s)
- Ashley J Wiese
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616
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Yaraghi A, Golparvar M, Talakoub R, Sateie H, Mehrabi A. Hypercapnic hyperventilation shortens emergence time from Propofol and Isoflurane anesthesia. J Res Pharm Pract 2014; 2:24-8. [PMID: 24991600 PMCID: PMC4076894 DOI: 10.4103/2279-042x.114085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: The aim of this study is to compare the effects of hypercapnic hyperventilation and normocapnic normoventilation on emergence time from propofol and isoflurane anesthesia. Methods: In this clinical trial, the differences in emergence time were evaluated in 80 patients undergoing elective abdominal surgery in Alzahra University hospital, Isfahan, Iran, in 2011-2012. Patients were randomly divided into four groups (groups 1-4) receiving isoflurane hypercapnic hyperventilation, isoflurane normocapnic normoventilation, propofol hypercapnic hyperventilation, and propofol normocapnic normoventilation, respectively. Hypercapnia was maintained by adding CO2 to the patient's inspired gas during hyperventilation. The emergence time and the duration of stay in recovery room in the four groups were measured and compared by one-way analysis of variance (ANOVA) and least significant difference tests. Findings: The average emergence time in groups 1, 2, 3, and 4 were (11.3 ± 3.2), (15.2 ± 3.8), (9 ± 4.2) and (11.8 ± 5.3) min, respectively. These differences were significant (P = 0.001). In patients receiving propofol hypercapnic hyperventilation, the emergence time was faster than in other groups. There was also a significant difference in duration of stay in recovery room between the groups (P = 0.004). Patients who received isoflurane hypercapnic hyperventilation had a shortest length of stay in the recovery room. Conclusion: The emergence time after intravenous anesthesia with propofol can be shortened significantly by using hyperventilation and hypercapnia, without any side effects.
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Affiliation(s)
- Ahmad Yaraghi
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Golparvar
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihanak Talakoub
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Sateie
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mehrabi
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Ferreira TH, Brosnan RJ, Shilo-Benjamini Y, Moore SB, Hollingsworth SR. Effects of ketamine, propofol, or thiopental administration on intraocular pressure and qualities of induction of and recovery from anesthesia in horses. Am J Vet Res 2013; 74:1070-7. [PMID: 23879844 DOI: 10.2460/ajvr.74.8.1070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effects of ketamine hydrochloride, propofol, or compounded thiopental sodium administration on intraocular pressure (IOP) and qualities of induction of and recovery from anesthesia in horses. ANIMALS 6 healthy adult horses. PROCEDURES Horses were sedated with xylazine hydrochloride (0.5 mg/kg), and anesthesia was induced with guaifenesin followed by ketamine (2 mg/kg), propofol (3 mg/kg), or thiopental (4 mg/kg) in a crossover study with ≥ 1 week between treatments. For each horse, IOP in the right eye was measured with a handheld applanation tonometer before and after xylazine administration, at the time of recumbency, and every 3 minutes after induction of anesthesia until spontaneous movement was observed. Cardiorespiratory responses and venous blood measurements were recorded during anesthesia. Induction of and recovery from anesthesia were subjectively evaluated by investigators who were unaware of the anesthetic treatment of each horse. Data were analyzed via a repeated-measures ANOVA with Holm-Ŝidák post hoc comparisons. RESULTS Compared with findings after xylazine administration (mean ± SD, 17 ± 3 mm Hg), thiopental decreased IOP by 4 ± 23%, whereas propofol and ketamine increased IOP by 8 ± 11% and 37 ± 16%, respectively. Compared with the effects of ketamine, propofol and thiopental resulted in significantly lower IOP at the time of recumbency and higher heart rates at 3 minutes after induction of anesthesia. No other significant differences among treatments were found. CONCLUSIONS AND CLINICAL RELEVANCE These findings support the use of thiopental or propofol in preference to ketamine for horses in which increases in IOP should be minimized.
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Affiliation(s)
- Tatiana H Ferreira
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, CA 95616, USA
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Abstract
Inhaled agents represent an important and useful class of drugs for equine anesthesia. This article reviews the ether-type anesthetics in contemporary use, their uptake and elimination, their mechanisms of action, and their desirable and undesirable effects in horses.
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Affiliation(s)
- Robert J Brosnan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
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